“Mark Perkins considers himself a poster child for the new generation of cancer drugs that harness the patient’s immune system to attack sick cells. Two years after trying Merck & Co.’s Keytruda — and almost four years after receiving a prognosis of as little as six months left to live — he is cancer free.

“The 56-year-old grandfather’s case is more than a success story for a new class of treatments that have fewer side effects than standard chemotherapy. It’s also at the frontier of what could possibly lead to a new approach to treating cancer, if it turns out that patients who, like Perkins, have many more mutations in their tumors than the average have a better chance of responding to immunotherapy.

“Drugs like Keytruda, known as checkpoint inhibitors, have produced dramatic responses in some advanced cancer patients, but doctors still don’t understand why only about 20 percent gain long-term survival. Researchers say looking at the mutation load for answers makes scientific sense, because these drugs work by taking the brakes off the immune system’s killer T-cells, unleashing them to go after cancerous cells. In theory, the more mutations a cancer has, the more foreign it will appear to the newly enhanced immune cells.”

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“Today, the U.S. Food and Drug Administration finalized its efforts to streamline the process used by physicians to request expanded access, often called “compassionate use,” to investigational drugs and biologics for their patients. As a physician, I understand the importance of being able to access investigational treatments for a patient when there are no other options to treat their serious disease or condition.

“Access to investigational treatments requires the active cooperation of the FDA, industry, and health care professionals in order to be successful. But we know that navigating that process can be challenging and time consuming, and we are committed to reducing the procedural burdens on physicians and patients whenever possible.”

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“At a time when PD-1 inhibitors are dominating the immunotherapy field, a team of researchers is seeking to use groundbreaking CRISPR gene editing technology for the first time in human beings to create an engineered T-cell agent that would knock out the gene that controls the immune checkpoint’s activity.

“Plans for the complex therapy call for taking NY-ESO-1, a peptide-based form of adoptive immunotherapy already in clinical trials, and disrupting the activity of the PDCD1 gene that encodes PD-1 as well as the endogenous TRAC and TRBC genes, which control T-cell receptor (TCR) alpha and beta, respectively.

“The goal would be to enhance the immune response with NY-ESO-1 by eliminating genomic drivers that hamper T-cell proliferation and function, University of Pennsylvania (UPenn) researchers said in describing the proposed study before a National Institutes of Health (NIH) panel on June 21.”

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“A startup called Strata Oncology says it plans to give away advanced genetic tests to 100,000 patients struggling with cancer. But there’s a profit motive: it hopes to identify patients with specific rare DNA errors and steer them to drug companies.

“Strata, which was founded last year and has raised $12 million from investors, says it is set up to run 50,000 next-generation sequencing tests a year. Such tests probe the DNA of tumor tissue, searching for mutations in hundreds of genes at once, hoping to surface clues about what drug a patient should be taking.

“Similar tests are already offered commercially to doctors by several companies, including Foundation Medicine of Cambridge, Massachusetts, and can cost $5,000 each.”

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“Pfizer Inc. PFE -0.26% today announced results from a Phase 1b trial of Pfizer’s investigational immunotherapy agent utomilumab (the proposed non-proprietary name for PF-05082566), a 4-1BB (also called CD137) agonist, in combination with pembrolizumab, a PD-1 inhibitor, in patients with advanced solid tumors. This is the first reported study of a 4-1BB agonist combined with a checkpoint inhibitor. Encouraging safety data from the study were shared today as an oral presentation at the 52 [nd] Annual Meeting of the American Society of Clinical Oncology (ASCO) in Chicago.

“ ‘While these are early data, the combination of utomilumab with pembrolizumab demonstrates an encouraging safety profile and an early indication of potential anti-tumor activity across solid tumors,’ said Anthony W. Tolcher, M.D., director of clinical research at South Texas Accelerated Research Therapeutics (START) San Antonio. ‘We believe these results warrant further investigation to confirm whether combining utomilumab with a checkpoint inhibitor may amplify anti-tumor responses.’ ”

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My job at Cancer Commons is to help cancer patients better understand and make decisions about their treatment. Through our Ask Cancer Commons service, I also strive to inform patients about new drugs in trials that they can discuss with their oncologists. Sometimes, I explain the rationale behind a patient’s current or upcoming treatment, and sometimes I try to convince patients to actually get treated, rather than hope that a vegetarian diet and herbal supplements will cure their metastatic disease. Continue reading…

“If you type ‘detox and cancer’ into an Internet search engine, you’ll get an avalanche of websites, articles, products, patient testimonials, and practitioners claiming that cancer can be prevented or even cured by diets or ‘cleanses’ that rid the body of ‘toxins.’ Are these approaches safe? Are they effective? It’s not necessarily as straightforward as you may think; the details really do matter, says Stacy Kennedy, MPH, RD, CSO, a senior nutritionist at Dana-Farber/Brigham and Women’s Cancer Center.

“Cancer immunotherapy relies on the stimulation of the patient’s own immune system for an effective and lasting anti-tumor response, targeting and eliminating cancer cells. Both the research and clinical communities believe that combining cancer immunotherapy with more traditional anti-cancer treatments, such as radiation, is one of the more exciting new research areas in cancer treatment.

“Charlie Garnett Benson, who is working on tumor immunity at Georgia State University, recently wrote about cancer immunity and combination therapy, the cutting-edge research areas listed in the new National Cancer Moonshot initiative highlighted by President Barack Obama in his final State of the Union address.

“Current cancer therapies include some combination of radiation, surgery, and chemotherapy for most patients. Ionizing radiation, one of the oldest and more commonly used types of cancer treatment, consists of high energy waves that damage the DNA of cancer cells leading to cell death, called cell suicide or apoptosis. But radiation can also affect the healthy cells surrounding tumor tissues, so there is a limit of how high a dose a patient can receive without leading to healthy cellular damage and death.”

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“The use of immunotherapy is increasing in cancer care, but more research is needed to measure the effectiveness of treatment, researchers write in a report published in the Journal of Clinical Oncology.

“Determining clinical efficacy can be challenging because of pseudoprogression and other distinct immune-related patterns of response that have been observed with these therapies.

“The WHO and the RECIST Group have traditionally provided standard guidelines for defining tumor response to therapy, note authors Victoria L. Chiou, MD, and Mauricio Burotto, MD, both from the National Cancer Institute.”

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